Chapter 25: Disorders of Renal Function Porth

Anomalies in ____ and _____ of the kidneys are the most common form of congenital renal disorder.

shape, position

The term dysgenesis refers to a failure of an organ to develop normally and ____ refers to complete failure of an organ to develop.

agenesis

Newborns with renal agenesis often have characteristic facial features, termed _____, resulting from the effects of the oligohydramnios.

Potter syndrome

In renal _____, the kidneys do not develop to normal size.

hypoplasia

Renal ____ is due to an abnormality in the differentiation of kidney structures during embryonic development.

dysplasia

Unilateral ____ renal dysplasia is the most common cause of an abdominal mass in newborns.

multicystic

____ kidneys diseases are a group of kidney disorders characterized by fluid-filled sacs or segments that have their origin in the tubular structures of the kidney.

Polycystic

In the ____ form of polycystic kidney disease, thousands of large cysts are derived from every segment of the nephron.

autosomal dominant

The ____ effects of urinary obstruction on kidney structures are determined by the degree and the duration of the obstruction.

destructive

_____ of urine predisposes to infection, which may spread throughout the urinary tract.

Stagnation

_____ refers to urine-filled dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to obstruction of urine outflow.

Hydronephrosis

Obstruction of the urinary track may provoke pain due to _____ of the collecting system and renal capsule.

distention

The most common cause of upper urinary tract obstruction is urinary ______.

calculi

In addition to a supersaturated urine, kidney stone formation requires a _____ that facilitates crystal aggregation.

nidus

Most kidney stones are ____ stones.

calcium

The major manifestation of kidney stones is _____.

pain

Urinary tract infections are the _____ most common type of bacterial infection seen by health care providers.

second

Most uncomplicated lower UTIs are caused by ____.

Escherichia coli

Most UTIs are caused by bacteria that enter through the ______.

urethra

Urinary tract infections are _____ common in women than men.

more

In UTIs associated with stasis of urine flow, the obstruction may be _____ or ______.

anatomic, functional

_____-associated bacteriuria remains the most frequent cause of Gram-negative septicemia in hospitalized patients.

Catheter

An acute episode of ______ is characterized by frequency of urination, lower abdominal or back discomfort, and burning and pain on urination.

cystitis

_____ is second leading cause of kidney failure worldwide and it ranks third, after diabetes and hypertension, as a cause of chronic kidney disease in the United States.

Glomerulonephritis

The _____ syndromes produce a proliferative inflammatory response, whereas the _____ syndrome produces increased permeability of the glomerulus.

nephritic, nephrotic

_____ syndrome is characterized by sudden onset of hematuria, variable degrees of proteinuria, diminished glomerular filtration rate, oliguria, and signs impaired renal function.

deposition

Acute postinfectious glomerulonephritis usually occurs after infection with certain strains of group A Beta-hemolytic streptococci and is caused by ____ of immune complexes.

hypercellularity

The _____ of postinfectious glomerulonephritis is caused by infiltration of leukocytes, both neutrophils and monocytes; proliferation of endothelial and mesangial cells; and in severe cases, formation of crescents.

Goodpasture

_____ syndrome is an uncommon and aggressive form of glomerulonephritis that is caused by antibodies to the glomerular basement membrane.

Nephrotic

_____ syndrome is characterized by massive proteinuria and lipiduria, along with an associated hypoalbuminemia, generalized edema, and hyperlipidema.

Membranous

____ glomerulonephritis is caused by diffuse thickening of the glomerular basement membrane due to deposition of immune complexes.

Membranous

_____ is a primary glomerulonephritis characterized by the presence of glomerular IgA immune complex deposits.

Berger disease

Alport syndrome represents a hereditary defect of the glomerular ____ that results in hematuria and may progress to chronic renal failure.

basement membrane

____ refers to a group of tubular defects in reabsorption of bicarbonate ions or excretion of hydrogen ions that result in metabolic acidosis and its subsequent complications, including metabolic bone disease, kidney stones, and growth failure in children

Renal tubular acidosis

Proximal renal tubular acidosis involves a defect in proximal tubular reabsorption of _____.

HCO3

_____ represents an infection of the upper urinary tract, specifically the renal parenchyma and renal pelvis.

Acute pyelonephritis

_____ is one of the most common primary neoplasms of young children.

Wilms tumor

Kidney cancer is suspected when there are findings of _____ and a renal _____.

hematuria, mass

Define urease

Urea splitting bacterial enzyme

Define hypogenesis

Low renal mass in infant

Define oliguria

Very low urine production

Define PKD 1 and 2

Genes responsible for autosomal dominant polycystic kidney disease (ADPKD)

Define Hydronephrosis

Dilation of the renal pelvis and calyces associated with progressive atrophy

Define Proteinuria

Protein loss in urine

Define Renal dysplasia

Change in renal structure

Define Nephrolithiasis

Kidney stone formation

Define Hematuria

Blood cells in urine

Define Oligohydraminos

Low amniotic fluid levels

What is the mechanism of tissue damage in urinary track obstructions?

The destructive effects of urinary obstruction on kidney structures are determined by the degree (i.e. partial versus complete, unilateral versus bilateral) and the duration of the obstruction. The two most damaging effects of urinary obstruction are stas

What are the factors involved in kidney stone formation?

Kidney stone formation requires supersaturated urine and an environment that allows the stone to grow. The risk for stone formation is increased when the urine is supersaturated with stone components (e.g. calcium salts, uric acid, magnesium ammonium phos

For whom are the risk factors for UTIs higher?

The risk factors for UTI are higher:
a. In persons with urinary obstruction and reflux.
b. In people with neurogenic disorders that impair bladder emptying
c. In women who are sexually active
d. In postmenopausal women
e. In men with diseases of the prost

What are the host defense mechanisms against the development of a UTI?

The host defenses of the bladder include the washout phenomenon, in which bacteria are removed from the bladder and urethra during voiding; the protective mucin layer that lines the bladder and protects against bacterial invasion; and local immune respons

What are the cellular changes associated with glomerular disease?

The cellular changes that occur with glomerular disease include decreases in glomerular and/or inflammatory cell number, basement membrane thickening, and changes in noncellular glomerular components.

Describe the disease progress and the production of symptoms in poststreptococcal glomerulonephritis.

The development of glomerulonephritis follows a streptococcal infection by approximately 7 to 12 days, the time needed for the production of antibodies. The primary infection usually involves the pharynx. Oliguria, which develops as the glomerular filtrat

Describe the mechanisms of a diabetic nephropathy.

Widespread thickening of the glomerular capillary basement membrane occurs in almost all persons with diabetes and can occur without evidence of proteinuria. This is followed by a diffuse increase in mesangial matrix, with mild proliferation of mesangial

How do medications and toxins from the environment damage renal structures?

Drug-related nephropathies involve functional or structural changes in the kidneys that occur after exposure to a drug. Because of their large blood flow and high filtration pressure, the kidneys are exposed to any substance that is in the blood. The kidn

An elderly woman, hospitalized with a broken hip, has an indwelling catheter in place. On the third day of hospitalization the woman's urine becomes cloudy and foul smelling. The nurse knows that catheters have a high incidence of causing UTIs in hospital

Urine analysis, urine culture and sensitivity and broad-spectrum antibiotic given intravenously.

Congenital disorders of the kidneys are fairly common, occurring in approximately 1:1000 live births. What is the result to the newborn when bilateral renal dysplasia occurs?

Potter facies, Oligohydraminos, Pulmonary hypoplasia, and Renal failure. Bilateral renal dysplasia causes olgiohydraminos and the resultant Potter facies, pulmonary hypoplasia, and renal failure. Multicystic kidneys are a disorder, not the result of a con

What type of cyst would autosomal dominant polycystic kidney disease (ADPKD) cause?

The tubule wall, which is lined by a single layer of tubular cells, expands and then rapidly closes the cyst off from the tubule of origin.

What type of cyst would autosomal recessive polycystic kidney disease (ARPKD) cause?

Small elongated cysts form in the collecting ducts and maintain contact with the nephron of origin.

What type of cyst would acquired cysts disorder cause?

Cysts that develop in the kidney as a consequence of aging, dialysis, or other conditions that affect tubular function.

What type of cyst would nephronophthisis-medullary cystic kidney disease cause?

Cysts are restricted to the corticomedullary border.

A young woman presents with signs and symptoms of a UTI. The nurse notes that this is the fifth UTI in as many months. What would this information lead the nurse to believe?

There is possible obstruction in the urinary tract. Urinary tract obstruction encourages the growth of microorganisms and should be suspected in persons with recurrent UTIs.

Staghorn kidney stones, or struvite stones, are usually located in the renal pelvis. These stones are made from what?

Magnesium ammonium phosphate. Phosphate levels are increased in alkaline urine and magnesium, always present in the urine, and combine to form struvite stones. These stones can increase in size until they fill an entire renal pelvis. Because of their shap

What is the most common cause of a lower UTI?

Most uncomplicated lower UTIs are caused by eschericia coli.

Urinary tract infections in children do not generally present as UTIs as they do in adults. What are the signs and symptoms of a UTI in a toddler?

Diarrhea, abdominal pain, and poor growth.Toddlers often present with abdominal pain, vomiting, diarrhea, abnormal voiding patterns, foul-smelling urine, fever, and poor growth Toddlers do not typically have frequency in voiding, nor do they complain of b

Acute postinfectious glomerulonephritis as its name implies, follows an acute infection somewhere else in the body. What is the most common cause of acute postinfectious glomerulonephritis?

Group A Beta-hemolytic streptococci have the ability to seed from one area of the body to another. One area it seeds to is the kidney, where it causes acute postinfectious glomerulonephritis. Other organisms can cause postinfectious glomerulonephritis, bu

Both type I and type II diabetes mellitus can cause damage to the glomeruli of the kidneys. What renal disease is diabetic nephropathy associated with?

Nephrotic syndrome.The lesions of diabetic nephropathy most commonly involve the glomeruli and are associated with three glomerular syndromes: nonnephrotic proteinuria, nephrotic syndrome, and chronic renal failure.

Acute pyelonephritis is an infection of the renal parenchyma and renal pelvis. What is the most common cause of acute pyelonephritis?

Pseudomonas aeruginosa. The most common causative agents of acute pyelonephritis are Gram-negative bacteria, including E.coli and Proteus, Klebsiella, Enterobacter, and Pseudomonas.

Drug-related nephropathies occur all too often. They involve functional and/or structural changes to the kidney after exposure to a drug. What does the tolerance to drugs depend on?

State of hydration. The tolerance to drugs varies with age and depends on renal function, state of hydration, blood pressure, and the pH of the urine

Wilms tumor is a tumor of childhood. It is usually an encapsulated mass occurring in any part of the kidney. What are the common presenting signs of a Wilms tumor?

Large asymptomatic abdominal mass and hypertension.The common presenting signs of a Wilms tumor are large asymptomatic abdominal mass and hypertension. The tumor is often discovered inadvertently, and it is not uncommon for the mother to discover it while